[7 years' experience with neonatal tetanus in Yucatan].

Forty-six patients with neonatal tetanus (NT) were studied to identify factors for poor prognosis which could be used to select a therapeutic regimen with intravenous diazepam or neuromuscular blockade (NB) with pancuronium. Nine patients with NT grades II and III were successfully treated with diazepam; none of them died. Of the patients with NT grades IV and V, 27 received diazepam and ten received pancuronium. The mortality rate in these groups was 55% and 100%, respectively. Factors predicting poor prognosis among patients treated with diazepam were apneas (P = 0.01), and an age on admission of seven days or less (P = 0.0002). Patients who received diazepam and died, generally presented a rapidly fatal course (mean of four days); in this group tetanus was the main cause of death (73%). Patients treated with pancuronium survived a comparably longer period (mean = 15.7 days, P = 0.05), but generally died from nosocomial infections (70%, P = 0.04). On the basis of our results we propose that NT grades IV and V with the aforementioned factors for poor prognosis be treated with NB. In hospitals with limited resources and high rates of nosocomial infection, we suggest that NT grades IV and V without such factors initially be managed with diazepam, reserving NB for therapeutic failures. Finally, NT grades I-III may be effectively treated with diazepam alone.